Multiple cranial neuropathies in cerebral venous sinus thrombosis

Abstract

Clinical presentation of cerebral venous sinus thrombosis (CVST) is varied and often mimics many neurological disorders, making it a diagnostic challenge, and cranial nerve palsy in CVST is rare and its pathophysiology remains unclear. We report a case of a 19-year-old male with a history of whiplash injury, admitted with extensive CVST, developed right facial nerve palsy with extension of thrombus into the ipsilateral transverse sinus, sigmoid sinus and internal jugular vein. Later, he developed left facial nerve palsy with partial left occulomotor weakness. We suggest that either reversible compromised oxygen or glucose consumption within the intrinsic vascular system of the nerve, resulting in cranial nerve abnormalities. CVST should be considered in cases of trivial trauma, even in the absence of hyper-coagulable states, and it can have atypical presentation like multiple cranial neuropathies.

Figure 1:

(A) the posterior half of the sagittal sinus is found to be thrombosed with the thrombus extending into the TS reaching the sigmoid sinus on the right side. (B) progression of the intraluminal hyperdensity previously to involve currently the straight sinus and possibly the left TS with mild effacement of cortical sulci. (C) sagittal sinus, right TS, right sigmoid sinus and right internal jugular vein with minimal partial recanalization.